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A lifestyle choice, attention seeking behaviour, a diet gone wrong – these are just some of the common myths surrounding eating disorders.1 The reality is very different.
“Eating disorders are complex mental health conditions, not lifestyle choices,” says Dr Agnes Ayton, vice-chair of the Royal College of Psychiatrists’ Eating Disorders Faculty.
“People who have an eating disorder often struggle with severe anxiety and are unable to maintain optimal nutritional intake. If untreated, eating disorders can become life threatening or lead to long term complications, says Dr Ayton.
‘Eating disorders are serious mental illnesses whereby people use disordered eating as a way to cope with difficult feelings or situations,” says Tom Quinn, director of external affairs for Beat, the UK’s eating disorder charity.
He says there are many different types of eating disorders, including anorexia, bulimia, binge eating disorder, OSFED (Otherwise Specified Feeding Eating Disorder) and ARFID (Avoidant/Restrictive Food Intake Disorder). “The most common eating disorder is binge eating disorder – we estimate that one in 50 people will experience this in their lifetime,’ says Mr Quinn.
Eating disorders becoming “increasingly common”
Beat estimates that around 1.25 million people in the UK have an eating disorder. 2 Mr Quinn says there is a “misconception that only women and girls develop eating disorders, but these mental illnesses affect people of all ages, genders, ethnicities, and backgrounds”.
The Health Survey for England in 2019 found that 19% of women aged sixteen and over screened positive for a possible eating disorder when questioned on their relationship with food. And around one in eight men (13%) also screened positive for a possible eating disorder in the same timeframe.3
“Sadly, we know that eating disorders are becoming increasingly common – between April 2021 and March 2022 we experienced three times the demand for our support in comparison to before the pandemic,” says Mr Quinn.
Dr Anu Sayal-Bennett is a consultant clinical psychologist of On-Track Partnership Limited, which provides consultancy and psychological services to individuals and groups in Harley Street and elsewhere, and an Associate Fellow of the British Psychological Society (BPS). She says there is a “epidemic of eating disorders”, and mental health support is becoming increasingly “difficult to access”.
Signs and symptoms of eating disorders
“One of the most common signs to look out for, is if a person is worrying excessively about their weight and body shape,” says Dr Ayton. “You might notice that they eat a very small amount of food, make themselves sick after eating, exercise excessively, or a combination of these things.”
Dr Ayton says people with anorexia nervosa and bulimia nervosa are worried about their weight and shape. She explains a person who has anorexia nervosa will try to control their weight by eating too little or exercising too much, leading to malnutrition.
An individual with bulimia nervosa may restrict their diet followed by episodes of bingeing and compensatory behaviours such as inducing vomiting or using medicines to try to lose weight, while binge eating disorder can cause a person to consume large portions of food until they feel uncomfortably full.
Dr Ayton says people with eating disorders often weigh significantly less or more than their peers of the same age, and this can take a physical toll on their body. They might develop dizziness, become faint or have problems with digestion.
She also notes that eating disorders are often associated with intense shame and “thrive in secrecy”. For this reason, she recommends concerned family members and friends should look out for lying about eating, avoiding eating with others and wearing baggy clothes to hide weight loss.
She says it should be noted that BMI is “an important but imprecise measure of health risk”. “A person of any age who has been at a higher weight for many years and then loses weight rapidly may have many of the symptoms and signs of malnutrition, even though their weight is still in, or close to, the normal range,” she says.
Mr Quinn says it is important to remember that eating disorders “are not all about food itself, but about feelings, and that not every person will experience changes in weight”.
Common symptoms of eating disorders“There are many different symptoms, and every person will experience an eating disorder differently,” says Tom Quinn, director of external affairs for Beat, the UK eating disorder charity. He says common signs can include:
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A “devastating impact” on lives
Eating disorders can have “a devastating impact on a person’s life and their loved ones”, says Mr Quinn. “The sooner somebody accesses quality treatment, the better their chances of making a full recovery, which is why it’s so important to keep an eye out for the early warning signs.”
“People with eating disorders often find it much harder to function at school or work and they can negatively affect people’s personal relationships as well, such as becoming withdrawn or irritable. There’s always a risk that eating disorders can become long-lasting if they aren’t treated quickly,” says Dr Ayton.
“In the most severe cases, eating disorders can pose a threat to life due to the physical health risks associated with low weight and malnutrition. They can also seriously impact people’s mental health and cognitive functioning,” she says.
When an individual has an eating disorder this can also impact on their family and friends. “Everybody is involved in the problem,” says Dr Sayal-Bennett, “but also, everybody can be involved in the solution.”
Treating eating disorders
“The best way to help people with eating disorders is to identify them quickly and provide them with access to care as soon as possible,” says Dr Ayton. “This makes it much less likely that they will develop a more complex and long-lasting condition. However, it’s important to note that even people who have had a disorder for many years can still recover.”
Treatments for eating disorders can vary depending on the type a person has, but Dr Ayton says most people will be offered a form of talking therapy.
“Family based treatment is most effective for children and young people, and cognitive behavioural therapy adapted for eating disorders is helpful across the diagnostic spectrum for adults. People who are very unwell might need to spend time in hospital to be monitored and receive intensive treatment to help them recover,” she added.
Eating disorders can be treated at specialised eating disorder units. This will involve having multi-disciplinary teams, including psychiatrists, psychologists, nutritionists, and family therapists, says Dr Sayal-Bennett. She adds there is no “quick fix” to treating eating disorders, and “you have to give it time”.
Supporting people with eating disorders, and their families
“[A healthcare professional] could be one of the first people to spot that a patient might have an eating disorder, even if they’re not aware of it themselves”, says Mr Quinn. “It’s really important to gently raise any concerns gently with your patient, for instance asking how they’re feeling about their relationship with food and exercise, and to make a referral to specialist treatment.”
Beat offers free training for healthcare professionals cross the UK (see resources box) to help assess risk and sensitively talk to patients about eating disorders. Healthcare professionals can also signpost people with eating disorders to support services, such as Beat.
However, eating disorder services are “struggling to cope with significant levels of demand due to a lack of sufficient resourcing”, says Dr Ayton. “They must be provided with the staff and resources they need to offer more timely care and bring down waiting lists.”
The Royal College of Psychiatrists has published Medical Emergencies in Eating Disorders guidance for frontline staff (see resources box), so that people needing urgent care can be identified and treated more quickly. “Eating disorder services should share this guidance with staff and ensure it is complied with where possible,” says Dr Ayton.
Practitioners also need to “check in regularly” with individuals and their families, says Dr Sayal-Bennett. It might be that blood tests are needed regularly, while others may need mental health support. Practitioners can also recommend and signpost people to resources, she says.
“Identifying eating disorders as soon as possible is key,” says Mr Quinn. “We’d urge every healthcare professional to follow up on any behaviour they find concerning in their patients, and to reach out to eating disorder experts for guidance.”
People may find it difficult to understand eating disorders and often assume individuals are simply choosing to eat too much or too little, says Dr Ayton.
“The truth is eating disorders are far more complex than this, and in too many cases they become life-threatening because people are afraid to share their concerns with friends and family or seek professional help,” she said. “As a society, we must do all we can to ensure people with eating disorders receive the love and care they need, rather than judgement or ridicule.”
Practitioners supporting individuals with eating disorders should focus on “not being judgemental”, and ensuring people “do not feel alone”, says Dr Sayal-Bennett.
She says practitioners need to adopt a “no blame” therapeutic position. “These people are struggling, they’re doing the very best they can. There can be no judgment or blame. There will be setbacks, there will be relapses. So, we mustn’t give up with our clients. We’ve got to be there to help them regain some self-esteem and help them to care for their bodies.”
References
- Beat (2024) Eating disorder myths. https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/eating-disorder-myths/
- Beat (2024) How many people have an eating disorder in the UK? https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/
- NHS Digital (2020) Nearly one in five women screened positive for possible eating disorder. https://digital.nhs.uk/news/2020/nearly-one-in-five-women-screened-positive-for-possible-eating-disorder
Resources
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